LCAS North Carolina Exam Prep 2026/2027 Licensed Clinical
Addiction Specialist – Complete Exam-Style Questions with Detailed
Rationales | 100% Verified – Pass Guaranteed – A+ Graded
CANDIDATE INSTRUCTIONS
Select the best answer. Use DSM-5-TR criteria, ASAM criteria, NAADAC Code of Ethics,
and North Carolina laws. Prioritize evidence-based, person-centered care. Suggested
time: 105 minutes.
SECTION A: SCREENING, ASSESSMENT & DIAGNOSIS (Questions
1–14)
1. A client reports drinking 6–8 beers daily for the past 10 years, has attempted to cut
down twice without success, and continues drinking despite a recent DUI arrest and
marital conflict. According to DSM-5-TR criteria, how many criteria for Alcohol Use
Disorder are present, and what is the severity?
A. 2 criteria; mild
B. 3 criteria; mild
C. 4 criteria; moderate
D. 5 criteria; severe
Correct Answer: C
Rationale: The client meets four criteria: tolerance (6–8 beers), unsuccessful efforts to
cut down, continued use despite social/interpersonal problems (DUI, marital conflict),
and likely impaired control; four criteria indicate moderate severity. The primary
distractor is A; 2 criteria would be mild, but the described pattern clearly exceeds that
threshold.
,2. A 34-year-old client presents to the emergency department after a motor vehicle
crash. The nurse screens for substance use using the CAGE-AID. Which response would
be scored as a positive screen?
A. "I have never felt the need to cut down on my drinking."
B. "I have felt annoyed by people criticizing my drug use."
C. "I always drink with friends, never alone."
D. "I have never had a drink first thing in the morning."
Correct Answer: B
Rationale: CAGE-AID items include feeling the need to Cut down, Annoyed by criticism,
Guilty about use, and Eye-opener use; "annoyed by criticism" is the "A" item and a
positive screen. The primary distractor is A; stating no need to cut down is a negative
response, not a positive screen.
3. During a biopsychosocial assessment, a client reports using intravenous heroin 2–3
times daily, last use 8 hours ago. The client describes yawning, lacrimation, rhinorrhea,
piloerection, and severe muscle aches. Which assessment tool should the clinician use
to quantify withdrawal severity?
A. CIWA-Ar
B. COWS
C. GAD-7
D. PCL-5
Correct Answer: B
Rationale: The Clinical Opiate Withdrawal Scale (COWS) is the validated instrument for
assessing opioid withdrawal severity, with the described symptoms being classic opioid
withdrawal manifestations. The primary distractor is A; CIWA-Ar assesses alcohol
withdrawal, which presents with tremors, autonomic hyperactivity, and risk of seizures
rather than the opioid withdrawal syndrome described.
4. A client presents for intake 6 hours after the last drink of a 2-week binge. Vital signs:
T 37.8°C, HR 118, BP 162/94, RR 24. The client is tremulous, diaphoretic, and reports
visual hallucinations of insects crawling on the walls. Which is the priority nursing
action?
A. Administer a benzodiazepine per CIWA-Ar protocol and initiate seizure precautions
,B. Provide oral thiamine 100 mg and reassess in 2 hours
C. Offer a drink of alcohol to prevent further withdrawal escalation
D. Discharge the client with a referral to outpatient detoxification
Correct Answer: A
Rationale: The presentation indicates moderate-to-severe alcohol withdrawal with
autonomic hyperactivity and hallucinations, placing the client at high risk for seizures
and delirium tremens; benzodiazepine protocol and seizure precautions are the
standard of care. The primary distractor is B; while thiamine is essential to prevent
Wernicke encephalopathy, it does not treat the acute withdrawal syndrome or prevent
seizures.
5. A client is being assessed for admission to a residential treatment program. Using
ASAM criteria (3rd edition), which dimension evaluates the client's risk of relapse and
potential for continued use?
A. Dimension 1: Acute intoxication and/or withdrawal potential
B. Dimension 3: Emotional, behavioral, or cognitive conditions and complications
C. Dimension 5: Relapse, continued use, or continued problem potential
D. Dimension 6: Recovery/living environment and social supports
Correct Answer: C
Rationale: Dimension 5 specifically addresses the client's history of relapse, triggers,
coping skills, and readiness for change as they relate to continued substance use risk.
The primary distractor is A; Dimension 1 assesses current intoxication and withdrawal
management needs, not longitudinal relapse potential.
6. A client reports using cocaine 3–4 times weekly for 6 months and stopped 2 days
ago. The client reports severe fatigue, vivid unpleasant dreams, increased appetite, and
psychomotor retardation. The client states, "I feel like I can't enjoy anything anymore."
Which is the most accurate clinical interpretation?
A. The client is experiencing a major depressive episode unrelated to substance use
B. The client is experiencing cocaine withdrawal, which typically includes depressive
symptoms and carries risk for suicidal ideation
C. The client has developed an independent bipolar disorder with depressive features
D. The client is malingering to obtain stimulant replacement therapy
, Correct Answer: B
Rationale: The described symptoms—fatigue, dysphoria, anhedonia, vivid dreams, and
psychomotor changes—are characteristic of cocaine withdrawal (crash), and the
associated depression carries significant risk for suicidal ideation requiring monitoring.
The primary distractor is A; while the symptoms resemble major depression, the
temporal relationship to cessation and lack of pre-existing mood disorder history
suggest a substance-induced condition.
7. A client is being screened for a substance use disorder using the AUDIT (Alcohol Use
Disorders Identification Test). Which score range indicates hazardous or harmful
alcohol use requiring brief intervention?
A. 0–7
B. 8–15
C. 16–19
D. 20–40
Correct Answer: B
Rationale: AUDIT scores of 8–15 for men and 7–14 for women indicate hazardous or
harmful alcohol use that warrants brief intervention and continued monitoring; higher
scores indicate dependence. The primary distractor is A; scores of 0–7 indicate low-risk
drinking and require no intervention.
8. A client reports a 15-year history of daily benzodiazepine use (alprazolam 4 mg/day
prescribed for anxiety). The client wants to stop using substances and enter treatment.
Which is the most appropriate level of care recommendation?
A. Outpatient counseling with weekly individual therapy
B. Intensive outpatient program with group therapy three times weekly
C. Medically managed inpatient detoxification due to seizure risk
D. Residential treatment without medical oversight
Correct Answer: C
Rationale: Benzodiazepine withdrawal carries risk of seizures, delirium, and death;
long-term high-dose use requires medically supervised tapering, typically in an inpatient
setting with seizure precautions and gradual dose reduction. The primary distractor is A;
Addiction Specialist – Complete Exam-Style Questions with Detailed
Rationales | 100% Verified – Pass Guaranteed – A+ Graded
CANDIDATE INSTRUCTIONS
Select the best answer. Use DSM-5-TR criteria, ASAM criteria, NAADAC Code of Ethics,
and North Carolina laws. Prioritize evidence-based, person-centered care. Suggested
time: 105 minutes.
SECTION A: SCREENING, ASSESSMENT & DIAGNOSIS (Questions
1–14)
1. A client reports drinking 6–8 beers daily for the past 10 years, has attempted to cut
down twice without success, and continues drinking despite a recent DUI arrest and
marital conflict. According to DSM-5-TR criteria, how many criteria for Alcohol Use
Disorder are present, and what is the severity?
A. 2 criteria; mild
B. 3 criteria; mild
C. 4 criteria; moderate
D. 5 criteria; severe
Correct Answer: C
Rationale: The client meets four criteria: tolerance (6–8 beers), unsuccessful efforts to
cut down, continued use despite social/interpersonal problems (DUI, marital conflict),
and likely impaired control; four criteria indicate moderate severity. The primary
distractor is A; 2 criteria would be mild, but the described pattern clearly exceeds that
threshold.
,2. A 34-year-old client presents to the emergency department after a motor vehicle
crash. The nurse screens for substance use using the CAGE-AID. Which response would
be scored as a positive screen?
A. "I have never felt the need to cut down on my drinking."
B. "I have felt annoyed by people criticizing my drug use."
C. "I always drink with friends, never alone."
D. "I have never had a drink first thing in the morning."
Correct Answer: B
Rationale: CAGE-AID items include feeling the need to Cut down, Annoyed by criticism,
Guilty about use, and Eye-opener use; "annoyed by criticism" is the "A" item and a
positive screen. The primary distractor is A; stating no need to cut down is a negative
response, not a positive screen.
3. During a biopsychosocial assessment, a client reports using intravenous heroin 2–3
times daily, last use 8 hours ago. The client describes yawning, lacrimation, rhinorrhea,
piloerection, and severe muscle aches. Which assessment tool should the clinician use
to quantify withdrawal severity?
A. CIWA-Ar
B. COWS
C. GAD-7
D. PCL-5
Correct Answer: B
Rationale: The Clinical Opiate Withdrawal Scale (COWS) is the validated instrument for
assessing opioid withdrawal severity, with the described symptoms being classic opioid
withdrawal manifestations. The primary distractor is A; CIWA-Ar assesses alcohol
withdrawal, which presents with tremors, autonomic hyperactivity, and risk of seizures
rather than the opioid withdrawal syndrome described.
4. A client presents for intake 6 hours after the last drink of a 2-week binge. Vital signs:
T 37.8°C, HR 118, BP 162/94, RR 24. The client is tremulous, diaphoretic, and reports
visual hallucinations of insects crawling on the walls. Which is the priority nursing
action?
A. Administer a benzodiazepine per CIWA-Ar protocol and initiate seizure precautions
,B. Provide oral thiamine 100 mg and reassess in 2 hours
C. Offer a drink of alcohol to prevent further withdrawal escalation
D. Discharge the client with a referral to outpatient detoxification
Correct Answer: A
Rationale: The presentation indicates moderate-to-severe alcohol withdrawal with
autonomic hyperactivity and hallucinations, placing the client at high risk for seizures
and delirium tremens; benzodiazepine protocol and seizure precautions are the
standard of care. The primary distractor is B; while thiamine is essential to prevent
Wernicke encephalopathy, it does not treat the acute withdrawal syndrome or prevent
seizures.
5. A client is being assessed for admission to a residential treatment program. Using
ASAM criteria (3rd edition), which dimension evaluates the client's risk of relapse and
potential for continued use?
A. Dimension 1: Acute intoxication and/or withdrawal potential
B. Dimension 3: Emotional, behavioral, or cognitive conditions and complications
C. Dimension 5: Relapse, continued use, or continued problem potential
D. Dimension 6: Recovery/living environment and social supports
Correct Answer: C
Rationale: Dimension 5 specifically addresses the client's history of relapse, triggers,
coping skills, and readiness for change as they relate to continued substance use risk.
The primary distractor is A; Dimension 1 assesses current intoxication and withdrawal
management needs, not longitudinal relapse potential.
6. A client reports using cocaine 3–4 times weekly for 6 months and stopped 2 days
ago. The client reports severe fatigue, vivid unpleasant dreams, increased appetite, and
psychomotor retardation. The client states, "I feel like I can't enjoy anything anymore."
Which is the most accurate clinical interpretation?
A. The client is experiencing a major depressive episode unrelated to substance use
B. The client is experiencing cocaine withdrawal, which typically includes depressive
symptoms and carries risk for suicidal ideation
C. The client has developed an independent bipolar disorder with depressive features
D. The client is malingering to obtain stimulant replacement therapy
, Correct Answer: B
Rationale: The described symptoms—fatigue, dysphoria, anhedonia, vivid dreams, and
psychomotor changes—are characteristic of cocaine withdrawal (crash), and the
associated depression carries significant risk for suicidal ideation requiring monitoring.
The primary distractor is A; while the symptoms resemble major depression, the
temporal relationship to cessation and lack of pre-existing mood disorder history
suggest a substance-induced condition.
7. A client is being screened for a substance use disorder using the AUDIT (Alcohol Use
Disorders Identification Test). Which score range indicates hazardous or harmful
alcohol use requiring brief intervention?
A. 0–7
B. 8–15
C. 16–19
D. 20–40
Correct Answer: B
Rationale: AUDIT scores of 8–15 for men and 7–14 for women indicate hazardous or
harmful alcohol use that warrants brief intervention and continued monitoring; higher
scores indicate dependence. The primary distractor is A; scores of 0–7 indicate low-risk
drinking and require no intervention.
8. A client reports a 15-year history of daily benzodiazepine use (alprazolam 4 mg/day
prescribed for anxiety). The client wants to stop using substances and enter treatment.
Which is the most appropriate level of care recommendation?
A. Outpatient counseling with weekly individual therapy
B. Intensive outpatient program with group therapy three times weekly
C. Medically managed inpatient detoxification due to seizure risk
D. Residential treatment without medical oversight
Correct Answer: C
Rationale: Benzodiazepine withdrawal carries risk of seizures, delirium, and death;
long-term high-dose use requires medically supervised tapering, typically in an inpatient
setting with seizure precautions and gradual dose reduction. The primary distractor is A;
